Code choices will hinge on presence of hypercapnia or hypoxia.
Treating patients who have chronic conditions can change how an anesthesiologist provides care in some circumstances, and might even allow for additional reimbursement. One example is a patient undergoing a procedure who has been diagnosed with acute exacerbation of chronic respiratory failure.
ICD-9: Currently, providers have three diagnosis choices in this situation, depending on the presence of hypercapnia or hypoxia from the results of blood gas analysis (which you’ll need to acquire from the surgeon or other physician).
For acute exacerbation of chronic respiratory failure, you report 518.84 (Acute and chronic respiratory failure).
Question: Our physician injected multiple branches of the genicular nerve (superior lateral, superior medial, and inferior medial). Do we report 64450 once, or bill it three times with modifier 51? Also, what would be the correct code for thermal radiofrequency ablation of this nerve?
Expect more comprehensive audits instead of desk reviews.
The HHS Office for Civil Rights has announced that it is yet again delaying Phase 2 of the HIPAA audits — with no definitive date set for the audits to actually begin. When the audits do start, however, they’ll be much more intense than previously planned. Here’s what you need to know to prepare.
Why the delay? “Phase 2 of the HIPAA audits was initially slated to begin in the fall of 2014 and was subsequently moved to late 2014 or early 2015,” noted Charlotte, N.C.-based attorney Chara O’Neale in a blog post for law firm Parker Poe. “Currently, no timeline has been provided as to when the next round of audits will officially begin.”
Decision also means ICD-10 will move forward this year.
Unfortunately, it was no April Fool’s joke that April 1 came and went with no final Congressional action to override the 21 percent Medicare pay cut.
Although the House passed the Medicare Access and CHIP Reauthorization Act (MACRA), the Senate failed to vote on the bill before departing for a two-week recess on March 27.
“Their failure to act leaves physicians facing a devastating 21 percent cut in Medicare reimbursements when the current Sustainable Growth Rate (SGR) payment patch expires on March 31,” said Robert M. Wah, MD, president of the AMA, in a March 27 statement.
The April 2015 CPT® Assistant ends your confusion about new drug identification and testing codes updated in the 2015 CPT® code set. Find out how the new reporting mechanism distinguishes testing procedures based on presumptive, definitive, and therapeutic drug assay categories instead of the old qualitative or quantitative methodology.
Reviewing the latest issue will also improve your understanding of how to report optical coherence tomography of the breast and total disc arthroplasty. Plus, solve an ICD-10-CM coding dilemma with an immunization coding scenario. To get spot-on guidance, simply type a code or keyword into SuperCoder.com’sCode Connect to see the April article that suits your needs.
- Drug Identification and Testing: 80100-80104, 80150-80299, 80320-80377, 82491-82492, 82541-82544, 83992
- ICD-10-CM Case Scenario: 90460-90461, 90471-90474, 90654, G0008
- Optical Coherence Tomography During Breast Surgery: 0351T-0354T
- Sacroplasty: 22511, 0200T, 0201T
- Total Disc Arthroplasty: 22554, 22845, 22851, 22856, 22858, 63075, 0375T, 0092T.
The latest selection of CPT® Assistant FAQs also provides guidance for a variety of areas. Find authoritative answers in a snap by looking for these codes and topics on Code Connect:
Rely on the note to get information you need to choose either K21.0 or K21.9.Rely on the note to get information you need to choose either K21.0 or K21.9.
If your office sees patients who complain of acid reflux and heartburn frequently, you will want to get comfortable with the new coding changes with ICD-10 in October.
ICD-9: You currently use ICD-9 530.81 (Esophageal reflux) on your gastroesophageal reflux disease (GERD) claims.
Question: We have patients who have instructions from their employers to get a 90-day drug supply to save the employer and the patient money. My pediatricians want to help our patients in this regard, but we aren’t sure if there are restrictions against giving out more than a 30-day supply of ADHD medications. Can you advise?
Audit delay doesn’t mean you can forget about privacy.
Ignore the HHS Office for Civil Rights’ upcoming HIPAA audits at your peril, experts warn.
Disregarding Phase 2 audits is no longer an option, Jared Festner, HIPAA specialist for Irvine, Calif.-based Medical Information Technology Group said in a statement. “If you think for one minute your [organization] won’t be under the microscope for everything from device encryption, to making sure that every policy and procedure is completely filled out and updated on a yearly basis, you’ll be kicking yourself once you receive fines of up to $1.5 million per offense.”
The delay in Phase 2 OCR audits doesn’t mean that you can relax your efforts to make sure you’re in compliance with all HIPAA regulations, said Charlotte, N.C.-based attorney Chara O’Neale in a blog post for law firm Parker Poe.
The RVUs aren’t all you need to observe.
As it turns out, things weren’t settled when CMS published the Medicare Physician Fee Schedule Final Rule in November last year.
Now you’ll need to pay attention to changes in payment and claims processing if you don’t want to face confusion as you bill for your lab services in 2015.
Do this: Just read the following updates, and you’ll have everything you need to understand your Medicare pay — for now.
Your Claims Should Be Moving Again
End-to-end testing reveals potential problems.
If you have questions about the ICD-10 transition, you’re not alone. Specialty societies, including the American Medical Association (AMA), are waiting for answers, too.
The AMA was among 100 medical groups that wrote to the Centers for Medicare & Medicaid Services (CMS) on March 4 seeking responses to ICD-10 issues that they believe have not been appropriately addressed. Although the groups didn’t go so far as to request a delay to the Oct. 1 implementation date, they did express strong concerns about the transition in the 7-page letter to Acting CMS Administrator Andrew Slavitt.
Chief among the issues were the results of CMS’s end-to-end testing periods, which revealed claim acceptance rates in the 76 to 89 percent range.